A NEW DAY IN CANCER TREATMENT - St. Joseph Medical Center

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A multidisciplinary approach is the standard approach formost cancers. The team of experts at the Cancer Instituteat St. Joseph Medical Center meet weekly and discusstreatment options prospectively.CANCERS OF THE COLON, RECTUM AND ANUS10Anal cancer is very distinct from colorectal cancer in many ways,including: risk factors, progression of disease and treatment. It is oneof the few solid organ tumors that is potentially curable without surgery.The combination of chemotherapy and radiation is very effective intreating this malignancy, often to the point where there is no moreevidence of disease. The standard treatment algorithm currently usedwas actually first described back in 1974 (Nigro ND, et al. Dis ColonRectum 17:354-8 1974). When chemotherapy and radiation are notenough, “salvage” surgery can be curative.A multidisciplinary approach is necessary for the cure of anal cancer.The team of experts at the Colorectal Oncology Center of the CancerInstitute at St. Joseph Medical Center, including surgeons, radiationoncologists, medical oncologists and gastroenterologists, is veryexperienced with the treatment of this rare tumor. From upfront stagingwith ultrasound and PET/CT, to tailoring a regimen of chemotherapy andradiation for each particular patient, to surgical removal if needed, allfacets of workup and treatment are addressed at the Center.Focus on Laparoscopyhospitalization after the operation and cosmesis. The concern manycancer surgeons had regarding these techniques is whether they areoncologically sound. In other words, does laparoscopy have the samepotential for cure of a given cancer in comparison to traditional surgery?In the realm of colon cancer surgery, this question was definitivelyaddressed by the COST trial in 2004 (N Engl J Med 350:2050-9 2004).This well-publicized study found that recurrence rates for colon cancerwere similar when colectomy was performed by either laparoscopicor traditional techniques. Not long thereafter, the American Societyof Colon and Rectal Surgeons released a statement enumeratingFigure 1ST. JOSEPH MEDICAL CENTERCOLORECTAL PRIMARY TUMORS BY SITEFIVE YEAR (2004-2008)Total Colon = 519 (75%)Rectum = 141 (20%)Anal = 32 (4%)Left Colon19027%TransverseColon8%Other3%Anal4%In recent years, minimally-invasive approaches to common surgicalconditions have received a lot of public attention. The techniques oflaparoscopy, in particular, have been applied to almost any operationthat can be performed in the traditional “open” fashion. The obviousbenefits of laparoscopy include: less postoperative pain, shorterRight Colon25838%Rectum14120%
“ For Jen, R.N.—I met her during my lung biopsy at St. Joseph Medical Center. She did more to teach me about my cancer and itstreatment during my pre-biopsy prep than anyone had yet done. It is because of her that I made the decision to seek all of mycancer treatment at the Cancer Institute. ” s J.G.Figure 2HISTOLOGY OF TUMORSthat laparoscopic colectomy for colon cancer is a safe alternative totraditional “open” technique when performed by a surgeon who isexperienced with this technique.The colon and rectal surgeons at the Colorectal Oncology Center,Drs. Berg and Akbari, are well-versed in the minimally-invasive/laparoscopic approach to colorectal cancer. In fact, the great majorityof the operations they perform for colorectal cancer are performed usingeither “straight” laparoscopy or a laparoscopically-assisted approach.Both surgeons, in fact, have been instructors in courses to teach othersurgeons these techniques.Our Own ResultsThe Cancer Institute takes pride in tracking and analyzing its owndata. Focusing on cancers of the colon, rectum and anus, the primarysites of these cancers from the years 2004-2008 can be seen inFigure 1. As can be seen, as with the national data mentioned earlier,colon cancer was the most prevalent, followed by rectal and anal.The histology of these tumors was overwhelmingly adenocarcinoma,the most common histology of colon and rectal cancers (Figure 2).Anal cancers have squamous histology. The most common malignancycategorized under the “other” category was the carcinoid (low-gradeneuroendocrine) histology. In regards to the age of patients with acolorectal cancer at diagnosis, the apex of the distribution curve wasin the mid 70s (Figure 3).HISTOLOGY DISTRIBUTION PERCENTAGEFigure 3NUMBER OF CASES100%90%80%70%60%50%40%30%20%10%0%35302520151050COLON RECTUM ANALST. JOSEPH CANCER INSTITUTEFIVE-YEAR COLORECTAL CANCER AGE DISTRIBUTIONAge at DiagnosisPoly. (Age at Diagnosis)Average Age = 69Median Age = 71Maximum = 95Minimum = 25AGE AT DIAGNOSISOtherRareCloagenicCarcinoidBasiloidSquamousAdenocarcinoma25 30 35 40 45 50 55 60 65 70 75 80 85 9011
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A NEW DAY IN CANCER TREATMENT - St. Joseph Medical Center

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